PT - JOURNAL ARTICLE AU - L. Saba AU - W. Brinjikji AU - J.D. Spence AU - M. Wintermark AU - M. Castillo AU - G.J.D. Borst AU - Q. Yang AU - C. Yuan AU - A. Buckler AU - M. Edjlali AU - T. Saam AU - D. Saloner AU - B.K. Lal AU - D. Capodanno AU - J. Sun AU - N. Balu AU - R. Naylor AU - A.v.d. Lugt AU - B.A. Wasserman AU - M.E. Kooi AU - J. Wardlaw AU - J. Gillard AU - G. Lanzino AU - U. Hedin AU - D. Mikulis AU - A. Gupta AU - J.K. DeMarco AU - C. Hess AU - J.V. Goethem AU - T. Hatsukami AU - P. Rothwell AU - M.M. Brown AU - A.R. Moody TI - Roadmap Consensus on Carotid Artery Plaque Imaging and Impact on Therapy Strategies and Guidelines: An International, Multispecialty, Expert Review and Position Statement AID - 10.3174/ajnr.A7223 DP - 2021 Jul 29 TA - American Journal of Neuroradiology 4099 - http://www.ajnr.org/content/early/2021/07/29/ajnr.A7223.short 4100 - http://www.ajnr.org/content/early/2021/07/29/ajnr.A7223.full AB - SUMMARY: Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.AHAAmerican Heart AssociationIPHintraplaque hemorrhageLRNClipid-rich necrotic core